Social Determinants of Health Dr Shahram Yazdani Shahid

Social Determinants of Health Dr. Shahram Yazdani Shahid Beheshti University of Medical Sciences School of Medical Education Strategic Policy Sessions: 01

Health Technologies Healthcare Disease Dr. Shahram Yazdani

Most Praised Health Technologies of 20 th Century 1. 2. 3. 4. 5. 6. 7. Dr. Shahram Yazdani 8. 9. Sulphonomides Diphteria Toxoid Poliomyelitis Vaccine Whooping Cough Vaccine Penicillin Chlaramphenicol Measles Vaccine Isoniazide Influenza Vaccine

Health Technologies Healthcare Accessibility Affordability Disease Dr. Shahram Yazdani

Health Technologies Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease Dr. Shahram Yazdani

Health Technologies Compliance Behavior Provider Professional Behavior Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease Dr. Shahram Yazdani

Interrupted Time Series 70 60 50 40 30 20 10 O O O O x. O O O O Dr. Shahram Yazdani

Interrupted Time Series 70 60 50 40 30 20 10 O O O O x. O O O O Dr. Shahram Yazdani

Interrupted Time Series 70 60 50 40 30 20 10 O O O O Dr. Shahram Yazdani O O O O x. O O O O

Dr. Shahram Yazdani

Health Technologies Compliance Behavior Provider Professional Behavior Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease Dr. Shahram Yazdani Environmental Risk Factors Lifestyle Behavior (RF) Genetic Risk Factors

Dr. Shahram Yazdani

Burden of disease attributable to 10 selected leading risk factors Dr. Shahram Yazdani

Burden of disease attributable to 10 selected leading risk factors Dr. Shahram Yazdani

Ten Tips For Better Health - Donaldson, 1999 Dr. Shahram Yazdani 1. Don't smoke. If you can, stop. If you can't, cut down. 2. Follow a balanced diet with plenty of fruit and vegetables. 3. Keep physically active. 4. Manage stress by, for example, talking things through and making time to relax. 5. If you drink alcohol, do so in moderation. 6. Cover up in the sun, and protect children from sunburn. 7. Practise safer sex. 8. Take up cancer screening opportunities. 9. Be safe on the roads: follow the Highway Code. 10. Learn the First Aid ABC : airways, breathing, circulation.

Social Determinants are Important

Social Determinants are Important Dr. Shahram Yazdani

Increased Risk of Diabetes in Ontario Among Low Income Residents, 1997/97 Dr. Shahram Yazdani

The Evidence Concerning Low Income and Heart Disease: The Hard Data • • Statistics Canada estimated that in 1996, 23% of years of life lost for all causes prior to age 75 in Canada could be attributed to income differences. The diseases most responsible for income-related differences in death rates were cardiovascular diseases. In 1996, 22% of all the years lost that can be attributed to income differences were caused by cardiovascular disease. These income differences account for an annual excess of 24% or 6, 366 premature deaths from cardiovascular disease. Dr. Shahram Yazdani

Health Technologies Compliance Behavior Provider Professional Behavior Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease Dr. Shahram Yazdani Environmental Risk Factors Lifestyle Behavior (RF) Social Determinants of Health Genetic Risk Factors

Dr. Shahram Yazdani

PYLL(0 -74) by Cause, 1996 % Dr. Shahram Yazdani

Dr. Shahram Yazdani

Socioeconomic Influence on Cardiovascular Disease Socioeconomic Position Dr. Shahram Yazdani Intrauterine Conditions Education & Environmental Conditions Working Conditions & Income & Assets Birth Childhood Adulthood Old Age Low Birth Weight Growth Retardation Smoking Diet, Exercise Job Stress Inadequate Medical Care Atherosclerosis CVD Reduced Function

Dr. Shahram Yazdani

Dr. Shahram Yazdani

Social Determinants of Health: The Solid Facts n n n § § n n Dr. Shahram Yazdani § Social gradient Early life Work Social support Stress Social exclusion Unemployment Addictions Food Transport World Health Organization, 1998

Ottawa Charter’s Prerequisites of Health n n n n Dr. Shahram Yazdani n Peace Shelter Education Food Income A stable eco-system Sustainable resources Social justice Equity World Health Organization, 1986

Health Canada’s Determinants of Health n n n n n Dr. Shahram Yazdani n n n Income and Social Status Social Support Networks Education Employment/Working Conditions Social Environments Physical Environments Personal Health Practices and Coping Skills Healthy Child Development Biology and Genetic Endowment Health Services Gender Culture

Health Compliance Behavior Provider Professional Behavior Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease Dr. Shahram Yazdani Environmental Risk Factors Lifestyle Behavior (RF) Social Determinants of Health Genetic Risk Factors

Ten Tips for Staying Healthy - Dave Gordon, 1999. Dr. Shahram Yazdani 1. Don't be poor. If you can, stop. If you can't, try not to be poor for long. 2. Don't have poor parents. 3. Own a car. 4. Don't work in a stressful, low paid manual job. 5. Don't live in damp, low quality housing. 6. Be able to afford to go on a foreign holiday and sunbathe. 7. Practice not losing your job and don't become unemployed. 8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled. 9. Don't live next to a busy major road or near a polluting factory. 10. Learn how to fill in the complex housing benefit/ asylum application forms before you become homeless and destitute.

n What is the role of governments? Dr. Shahram Yazdani

Dr. Shahram Yazdani

Dr. Shahram Yazdani

USA, Canada, and Sweden Rankings on Compared to other Industrialized Nations (Ranking, 1 is best) Dr. Shahram Yazdani Measure Income Inequality (1990) Child Poverty (1990) Infant Mortality (1996) Youth Suicide (1992 -1995) High School Drop-Outs (1996) Youth Homicide (1992 -1995) Wages (1996) Unemployment (1996) Elderly Poverty (1990) Life Expectancy (1996) USA 18 of 18 17 of 17 24 of 29 15 of 22 17 of 17 22 of 22 13 of 23 2 of 10 15 of 17 20 of 29 Canada 11 14 17 16 16 19 15 7 4 4 Sweden 3 2 2 10 10 5 6 8 5 3

Canadian Government Statements on Social Determinants of Health All policies which have a direct bearing on health need to be coordinated. The list is long and includes, among others, income security, employment, education, housing, business, agriculture, transportation, justice and technology. -- Achieving Health For All: A Framework for Health Dr. Shahram Yazdani Promotion, J. Epp. Ottawa: Health and Welfare Canada, 1986.

Justice and Fairness Where a great proportion of the people are suffered to languish in helpless misery, that country must be ill-policed and wretchedly governed: a decent provision for the poor is the true test of civilization. - Dr. Samuel Johnson Dr. Shahram Yazdani

n n n n Dr. Shahram Yazdani n n We know what makes us ill. When we are ill we are told That it’s you who will heal us. When we come to you Our rags are torn off us And you listen all over our naked body. As to the cause of our illness One glance at our rags would Tell you more. It is the same cause that wears out Our bodies and our clothes. Bertolt Brecht, A Worker’s Speech to a Doctor, 1938.

Thank You ! Dr. Shahram Yazdani